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paediatric

Congenital Muscular Torticollis

intermediate
6 min
28 marks
6 questions
Clinical Scenario
A 4-month-old girl is referred by her pediatrician for a head tilt noticed since birth. The parents report she always looks to the left side. Delivery was vaginal with breech presentation. On examination, the head is tilted to the right with chin rotation to the left. A firm, non-tender 2cm mass is palpable in the right sternocleidomastoid muscle. There is 30 degrees of passive rotation to the right (normal 80 degrees). Facial asymmetry is noted with right-sided flattening. Hip examination is normal.
Clinical photograph of a 4-month-old infant with right-sided congenital muscular torticollis. The head is tilted toward the right (affected side) with chin rotation to the left (opposite side). There is palpable fibrotic mass in the right sternocleidomastoid muscle. Facial asymmetry is visible with flattening of the right face (plagiocephaly). The infant has full passive range of motion when stretched. This presentation is typical of the sternomastoid tumor variant.
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Clinical photograph of a 4-month-old infant with right-sided congenital muscular torticollis. The head is tilted toward the right (affected side) with chin rotation to the left (opposite side). There is palpable fibrotic mass in the right sternocleidomastoid muscle. Facial asymmetry is visible with flattening of the right face (plagiocephaly). The infant has full passive range of motion when stretched. This presentation is typical of the sternomastoid tumor variant.

Image source: Open Access medical literature (NIH/PubMed Central) • CC-BY License

Questions

Question 1 (4 marks)

Describe the clinical presentation and classification of congenital muscular torticollis.

Question 2 (5 marks)

Explain the pathophysiology and associated conditions.

Question 3 (6 marks)

What is the management algorithm including physiotherapy and indications for surgery?

Question 4 (5 marks)

Describe the surgical technique for SCM release.

Question 5 (4 marks)

What are the differential diagnoses of torticollis in children?

Question 6 (4 marks)

What are the complications and outcomes?

Exam Day Cheat Sheet

Must Mention

  • •Head tilts TOWARD, chin turns AWAY
  • •3 types: Sternomastoid tumor, Muscular, Postural
  • •DDH association - MUST screen hips
  • •90% resolve with stretching by 1 year
  • •Surgery if: >1 year AND >15° deficit
  • •Bipolar release = proximal + distal

Common Pitfalls

  • •Wrong tilt direction
  • •Missing DDH screening
  • •Too early surgery (<1yr)
  • •Not knowing structures at risk
  • •Missing red flags
  • •No stretching specifics